Provider Demographics
NPI:1891880373
Name:HOLDEN, DONNIE JOE (MD)
Entity type:Individual
Prefix:
First Name:DONNIE
Middle Name:JOE
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 SE G ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3740
Mailing Address - Country:US
Mailing Address - Phone:479-367-2552
Mailing Address - Fax:479-367-2584
Practice Address - Street 1:2707 SE G ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3740
Practice Address - Country:US
Practice Address - Phone:479-367-2552
Practice Address - Fax:479-367-2584
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-73972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1891880373Medicaid
OK100080220AMedicaid
AR118344001Medicaid